Preterm labour and prematurity (original) (raw)
2007, Obstetrics, Gynaecology & Reproductive Medicine
Preterm birth occurs as a result of spontaneous preterm labour, in most cases associated with infection/inflammation and preterm pre-labour rupture of membranes. About 1/4 cases are iatrogenic. The incidence of preterm birth continues to increase in both developed and developing countries; most perinatal morbidity and mortality results from preterm births at less than 30 weeks' gestation. The prediction of spontaneous preterm birth has improved significantly, particularly through the use of transvaginal ultrasonography and fetal fibronectin testing. However, preventive measures such as tocolysis, cervical cerclage, progestogen and antibiotics have made little impact on outcome and require further evidence-based evaluation. in day-to-day clinical practice, interventions are often chosen based on personal preference, poor evidence of efficacy and the need to 'do something'. Accurate identification of at-risk women and cautious intervention in an evidence-based manner is advocated with careful consideration of the risks and benefits until further information is available to guide management.
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PRETERM LABOUR: A STUDY OF ETIOLOGICAL RISKFACTORS AND PERINATAL OUTCOME
Objective: To study the causes associated with preterm labour and the perinatal outcome in preterm labour. Methods: This prospective observational study was conducted in the department of obstetrics and gynaecology NDMC Medical College and Hindu Rao Hospital over a period of 6 months (Jan to June 2016). All patients presented with preterm labour, preterm premature rupture of membrane and with conditions where labour was iatrogenicallyinduced prematurely were included in the study. All the patients were divided into four groups depending upon the gestational age – less than 28 weeks, 28 to 31 weeks, 32 to 34 weeks and more than 34 weeks. Risk factors and the perinatal outcome were analyzed. Results: Out of 4382 patients delivered 946 were preterm delivery (21.5%).54 out of 946 preterm deliveries had come with intrauterine death. The commonest risk factor of preterm delivery was preterm premature rupture of membrane followed by infection, anemia, preeclampsia and abruption. 73.2% of patients went into spontaneous preterm labour and 26.8% had caesarean section. Maximum perinatal complications and death were seen in group with gestational age less than 28 weeks. Conclusions: The most common associated cause for preterm birth was preterm premature rupture of membrane. Perinatal outcome improves with gestational age. All preterm deliveries should be conducted in tertiarycare hospital where better neonatal care is available.
A prospective analysis of etiology and outcome of preterm labor
2007
To identify etiological factors and to assess the neonatal mortality and morbidity associated with preterm labor and delivery. METHOD(S) : In this prospective cohort study conducted over a 8 months period (January to August 2005) 416 antenatal women admitted with threatened preterm labor and in preterm labor, with or without rupture of membranes, were recruited. They were followed up from admission till delivery and discharge. Gestational age at onset of preterm labor, associated risk factors, response to tocolytics if given, gestational age at delivery, and neonatal outcome were recorded and analyzed. RESULTS : Incidence of preterm labor was 22% and that of preterm deliveries 20.9% Preterm rupture of membranes and infection were the commonest causes of preterm labor. Irrespective of the use of a course of betamethasone, neonatal mortality was significantly high (P<0.0001) in babies delivering before 34 weeks (30.4%) as compared to that in babies delivering after 34 weeks (3.4%). Septicemia, respiratory distress syndrome (RDS) and birth asphyxia were the important causes of neonatal morbidity. RDS was significantly reduced in those who completed steroid cover (P=0.029). CONCLUSION(S) : There is a high incidence of preterm labor and preterm births in our set up, compared to developed countries. Infection is one important modifiable risk factor which can be curtailed. Prolongation of delivery for 48 hours by giving tocolysis for getting the benefit of betamethasone coverage reduces morbidity due to RDS but does not reduce overall neonatal mortality below 34 weeks.
IntechOpen eBooks, 2021
Preterm delivery is defined as delivery before 37 weeks completed gestation. It represents a major cause of neonatal morbidity and mortality and accounts for 5-10% of all deliveries. Cervical length assessment between 16-24 weeks and positive fetal fibronectin beyond 21 weeks gestation are proved to useful tools in prediction of preterm labour. Treating asymptomatic bacteruia and bacterial vaginosis in high-risk women reduces the incidence of preterm labour. Cervical cerclage is recommended to reduce the incidence of preterm birth in women with 2nd trimester losses and those with cervical length of 25 mm or less on transvaginal ultrasound between 16-24 weks gestation. Atosiban and nifidipine are currently the agents of choice in tocolysis. Antenal steriods in womens with threating preterm labour reduces the perinatal morbidties. Magnisum sulphate role is established for neuroprotection especially in extreme gestations between 24-30 weeks. Vaginal delivery is mode of choice for delivery with consideration to avoid fetal blood sampling, fetal scalp electrodes and ventouse prior to 34 weeks gestations. Caesarean section is considered for obstetric reasons that guide labour management at term.
Guidelines for the management of spontaneous preterm labor
Journal of Perinatal Medicine, 2000
Preterm birth is defined as delivery at -37 completed weeks of pregnancy (World Health Organization). Spontaneous preterm birth (SPB) includes preterm labor, preterm spontaneous rupture of membranes, preterm premature rupture of membranes (PPROM) and cervical weakness; it does not include indicated preterm delivery for maternal or fetal conditions. Early SPB (-32 weeks' gestation) is associated with an increased higher perinatal mortality rate, inversely proportional to gestational age. The pathophysiologic events that trigger SPB are largely unknown but include decidual hemorrhage (abruption), mechanical factors (uterine overdistention or cervical incompetence), and hormonal changes (perhaps mediated by fetal or maternal stress). In addition, several cervicovaginal infections have been associated with preterm labor. SPB is also the leading cause of long-term morbidity, including neurodevelopmental handicap, cerebral palsy, seizure disorders, blindness, deafness and non-neurological disorders, such as bronchopulmonary dysplasia and retinopathy of prematurity. Delaying delivery may reduce the rate of long-term morbidity by facilitating the maturation of developing organs and systems. The benefits of administration of antepartum glucocorticosteroids to reduce the incidence and severity
Epidemiology and causes of preterm birth
Lancet, 2008
This paper is the fi rst in a three-part series on preterm birth, which is the leading cause of perinatal morbidity and mortality in developed countries. Infants are born preterm at less than 37 weeks' gestational age after: (1) spontaneous labour with intact membranes, (2) preterm premature rupture of the membranes (PPROM), and (3) labour induction or caesarean delivery for maternal or fetal indications. The frequency of preterm births is about 12-13% in the USA and 5-9% in many other developed countries; however, the rate of preterm birth has increased in many locations, predominantly because of increasing indicated preterm births and preterm delivery of artifi cially conceived multiple pregnancies. Common reasons for indicated preterm births include pre-eclampsia or eclampsia, and intrauterine growth restriction. Births that follow spontaneous preterm labour and PPROM-together called spontaneous preterm births-are regarded as a syndrome resulting from multiple causes, including infection or infl ammation, vascular disease, and uterine overdistension. Risk factors for spontaneous preterm births include a previous preterm birth, black race, periodontal disease, and low maternal body-mass index. A short cervical length and a raised cervical-vaginal fetal fi bronectin concentration are the strongest predictors of spontaneous preterm birth.
A study of etiology and outcome of preterm birth at a tertiary care centre
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Background: Preterm births are still the leading cause of perinatal mortality and morbidity. It is a major challenge in the obstetrical health care.Methods: This study was conducted over a period of eight months from September 2016 till April 2017 at a tertiary care hospital. All patients who delivered a live baby before 37 weeks of gestation were included in the study.Results: Present study was conducted on 100 eligible women out of which 7 delivered before 30 weeks but majority of them (55%) delivered after 34 weeks of gestation. In our study, most of the patients (66%) presented in active phase of labor which resulted in preterm birth of baby. The most common risk factor of preterm labor was genitourinary tract infections (34%) followed by Preterm Premature rupture of membranes (22%). Past obstetric history of preterm delivery and abortions also had a significant impact on the present pregnancy outcome.Conclusions: Preterm labour and birth still have a high incidence causing sign...
Overview. Preterm labour: mechanisms and management
BMC Pregnancy and Childbirth, 2007
Preterm birth remains a major cause of perinatal mortality and long term handicap in surviving infants. This is one of the most important clinical problems in Europe and across the world. While some preterm births are iatrogenic, associated with severe complications of pregnancy (e.g. hypertensive disorders, antepartum haemorrhage, infection), or the result of multiple pregnancies following assisted reproduction, a high
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